Preoperative evaluation of parathyroid lesions in patients with concomitant thyroid disease: role of high resolution ultrasonography and dual phase technetium 99m sestamibi scintigraphy

Abstract

The aim of this study was to evaluate the sensitivity and usefulness of high resolution ultrasonography (US) and dual phase technetium-99m sestamibi (Tc-MIBI) scintigraphy in the preoperative localization of parathyroid lesions in patients with or without thyroid disease and to define the impact of the presence of thyroid disease on these methods. Preoperative US and scintigraphy were performed on 52 patients with primary hyperparathyroidism. Age, gender, preoperative parathyroid hormone level, serum calcium level, serum phosphate level, diameter, location, associated with thyroid abnormality, and results of parathyroid exploration were determined in all patients. The results of US and Tc-MIBI imaging were analyzed and compared with surgical and histopathologic findings. At surgery, 56 parathyroid lesions were found in 52 patients (9 men, 43 women), the parathyroid lesion was solitary (47 adenomas, two hyperplasias), in 2 patients double adenomas were present, in 1 patient three glands was affected by hyperplasia. Twenty-seven patients had concomitant thyroid disease. The overall sensitivity of US and Tc-MIBI scintigraphy was 84% and 73%, respectively. In patients without thyroid disease, the sensitivity of these techniques was 90% and 75%, respectively. In patients with thyroid disease, the sensitivity was 78% and 70%, respectively. In patients with thyroid disease, the combined sensitivity of these techniques was 89%. These results allow the conclusion that, in experienced hands, US is a highly sensitive technique. Especially in patients with no thyroid pathology and typical located gland, US alone should be used as a first step for preoperative localization of parathyroid lesions. When negative, Tc-MIBI scintigraphy is suggested. In patients with concomitant thyroid disease, the combination of US and Tc-MIBI scintigraphy represents a reliable localization technique.

Role of ultrasonography in the management of patients with primary hyperparathyroidism: retrospective comparison with technetium-99m sestamibi scintigraphy

“…The results of the statistical analysis of data from group C confirm the findings of numerous other studies [29][30][31][32], that is that preoperative use of ultrasound and scintigraphy in parallel improves accuracy in the detection and localization of single pathological parathyroid glands In fact, the use of both methods was associated with higher diagnostic sensitivity (87 %) than use of ultrasound (71 %) or scintigraphy (73 %) alone. We nonetheless feel that, as reported in previous studies, the inferior sensitivity of ultrasonography observed in Group C is due to the absence of dedicated physician sonographers and/or to the relative lack of experience of some of the examiners.…”

Parathyroid sonography: Imaging and intervention

“…The reported sensitivity of sestamibi scintigraphy is similar to sonography, ranging between 73-93% with a positive predictive value of 89-97%. 52,60,61,63,64,[66][67][68] The sensitivity and positive predictive value of scintigraphy also decrease in the presence of multigland parathyroid disease and multinodular thyroid disease. Other imaging modalities such as MRI and CT have also been used.…”

The impact of surgeon-based ultrasonography for parathyroid disease on a British endocrine surgical practice

“…It is effective in identifying parathyroid disease although its reported sensitivity varies widely from 42% to 96%. 4,10,[15][16][17][18][19][20][21] Ultrasonography is well recognised as being 'operator dependent' and the accuracy of parathyroid ultrasonography has been shown to be affected by operator experience. 4,5,17 A dedicated, experienced parathyroid ultrasonographer optimises preoperative parathyroid localisation whereas multiple ultrasonographers of varying experience performing less parathyroid ultrasonography may compromise parathyroid localisation.…”

“…21 One unexpected finding was a trend towards inferior parathyroid glands being easier to identify than superior glands, perhaps due to their more superficial location in the neck and the optimisation of neck extension under anaesthesia.…”